I woke up all set to write about the pernicious effects of consequentialism, since I am kicking myself for not forcing Grace to go to the ER the night before she died. I was certain something was wrong, but not fatally wrong, and she was adamant that all she needed was a good night’s sleep. If she wasn’t better in the morning I had resolved to call the EMTs.
Right now, I’m too exhausted to write much more than that.
Ethics Alarms 
Jack,
If Grace was adamant, and you didn’t have cause to believe whatever ailed her was fatal, you made the best decision you could have. Yes, you could have tossed all precedent out the window and done something you did not feel fully justified in doing at the moment. I urge you, though, not to dwell on that. It wasn’t your fault.
Even the very wise cannot see all ends.
With all our love for you and yours,
Ryan
You can’t beat yourself up about that, Jack. If Grace was opposed and you weren’t 100% sure she was wrong on this one, then you did the right thing by respecting her expressed wishes. I’ve been there too and did in fact call the EMS to try to save my mom despite her protesting to the contrary. They did the best they could, but at the hospital she fell apart medically (her body was in bad shape from cancer and consequent treatment) and even a whole team of doctors and nurses wasn’t enough. Eventually I made peace with the fact that it could not have played any differently. It took time, though, and everyone, including yourself, must grieve and process at his/her own pace. Hopefully you have some support from your son and your families.
Don’t beat yourself up, Jack. Steve has a a really good point. My grandfather checked himself out of the hospital against doctor’s orders. I called him and talked to him that night and he was kicked back in the recliner watching his TV. He felt so much better out of that hospital and in his own home. He died at 3 AM from a blood clot they hadn’t detected. It would have killed him in the hospital also, but his last day was a good day and not a miserable day in the hospital. My grandmother went to the hospital when she didn’t need to and they killed her by not reading her chart, giving her a medication she was allergic to, and misdiagnosing her into an unnecessary double bypass. Her last words were “Stop them, let me go!” after they punctured her lung. You made a reasonable decision and there is a good chance that going to the ER would have made no difference. I know this won’t stop you from second guessing right now, but maybe it will help you stop sooner.
I am really sorry and can’t imagine what you are going through right now.
It’s easy to look back and play the “What if?” game here. The only information you had was what you had at the time. She said she just needed to sleep. Would you have tossed her over your shoulder and forced her into the car anyway?
I’m sorry this has happened. Spending time second guessing what you should have done will not help you.
I think that consequentialism, especially in the face of a tragedy, can be dangerous. I know that it is hard to avoid, but do not let it overwhelm you.
Two of my younger cousins died in self-inflicted ways in my twenties. When I was 23, my 21-year-old cousin did his traditional Thanksgiving evening bash with his friends. We all knew that he imbibed rather recklessly during this time, and had for years. This year, he had been suffering from mono and still went out to the party. At about 3AM, he called his younger sister to act as a DD. She, like most of the world, was asleep at 3AM and did not hear the call. She had made him promise to call, but she slept through it. He decided to drive the ten miles between farming towns instead of calling again, or trying someone else. He did not make it home, and the next morning, was found off a steep shoulder. His sister was racked with guilt for years for not hearing his call or staying up until he did so. She knew he’d call her, she just didn’t know when and if she’d have stayed up to the random time that he planned to come home, she could have saved him, or as we pointed out, killed them both because she would have been too tired to drive.
About six years later, my 26 year old cousin had been going through some tough times. About three months prior, his serious girlfriend (he had been planning the pop the question) died in a car crash. We had all been watching him closely for about six weeks when he seemed to stabilize. He had been told by every single one of us that if he needed something, we were a phone call away, but continued vigilance is hard on everyone, including him, so we were starting to give him the space he needed to heal, or so we thought. He lived in his sister’s basement apartment and had dinner with her family or his parents nearly every night. His sister, my cousin, came to my daughter’s baptism, along with my aunt one day. My cousin had a feeling early that morning that she should check on her brother, but she decided not to because she was giving him space and he had been told that he should inform her if he needed anything. He was found late that afternoon having consumed both alcohol and heroine. This incident has eaten her up. She had no knowledge of his purchasing the heroine. She heard a sound in the early morning, which was why she had thought to check on him. The coroner had assured her many times that he was already dead at that point, so she could have done nothing. It doesn’t matter what she was told. She has been letting the guilt of that eat her up, and only the years and the fact that she now has a two additional children has kept that from overwhelming her.
Please take care of yourself. Don’t let the choices you made with the best intentions become a whip to flog yourself with.
Jack,
My wife and mother-in-law are going through the “what if” torture right now. I tell them they shouldn’t second guess their decisions but it is a difficult process when you are grieving the loss of someone you love and adore.
A bit of background: My 85 year old father-in-law suffered a heart attack just before Thanksgiving last year. My wife took him to the emergency room and they admitted him to the hospital where he was diagnosed with a heart attack and congestive heart failure. He spent three and a half weeks in the hospital and a once vital and vigorous man lost close to 20 pounds and most of his body strength. The hospital stay alone took a huge toll on him. His doctors were great but he had other complications that ruled out performing a stint. He was discharged a week before Christmas. My wife and I brought him and my mother-in-law to our home to care for him and her.
Now, if astrology has any merit (it absolutely does not!) and persons born under the sign of Taurus are thought to be stubborn, well, my father-in-law embraced his stubbornness and molded it into an art form. He was a wonderful man and I could not have asked for a better father-in-law but he did things on his own terms and that was that – it served him very well as he never suffered fools well.
My wife’s family (my father-in-law, mother-in-law their children [my wife, her brothers and their respective children and our son]), celebrated Christmas at our home. My father-in-law enjoyed that time, he was a peace, surrounded by his family and well loved.
After Christmas, he got weaker. On December 30, his breathing was labored and he was agitated. My wife and mother-in-law wanted to take him to the hospital. He flat out refused. I deferred to his wishes as I felt he had made it clear he did not want any further hospital stays. I also realized that there was very little to be done for him.
He passed away in the early morning hours on December 31, 2023. While it was painful and my wife and her mother are wracked with sorrow thinking they could have/should have done more, they made the right decision to honor his wishes. He passed away in his sleep and was at peace. If he had passed away in the hospital, it would have added a different level of pain to my wife and her family.
The saying “time heals all wounds” might be appropriate. Right now, though, your heart and soul are grieving, and are heavy with loss. Remember that your family and friends are there to help you shoulder the burden. Keeping up with routines helps – walking the pooch, cutting the grass, yelling at the TV, listening to Rush. In times of need, it is okay to reach out and ask for help.
jvb
Jack,
Based on your, “If she wasn’t better in the morning I had resolved to call the EMTs” it’s clear that your concern was greater than hers but she was the one that was in control of her own body. She knew her body better than any other person on the planet and it sounds like you had some kind of a conversation about medical attention since you shared that “she was adamant that all she needed was a god night’s sleep”, I’m sure she wouldn’t have been adamant if you hadn’t talked a little about seeking medical attention. You respected her choice because “nothing… suggested that she was in mortal peril” and that Jack is a very, VERY important point that you cannot allow yourself to forget.
Without sharing all the medical details, if I forced my late mother to the ER every time she had a bad day, didn’t feel quite right, was anxious, etc, and had told me that all she needed was a god night’s sleep I would have been in the ER at least a couple times a week with my mother for the last 3 to 4 years of her life and I’m sure that each time I ignored her opinion and forced her to go would have built unneeded friction between us. To be clear, my late mother had all kinds of medical issues but I’m sure the ER would have seen a hypochondriac (the boy who cried wolf) walking in the ER doors. To be really clear, all she needed was a god night’s sleep was about as common as breathe for my mother.
My point is that sometimes getting a good night’s sleep can be a game changer in how someone feels and I can attest to that very thing after suffering the last month and a half with getting little to no sleep because of a rotten virus (not COVID) that plugged up my head so bad and I coughed so much that and I had to try to sleep sitting up in a lounge chair. I honestly don’t think I got any REM sleep for most of that month and a half, I felt terrible. One night sleeping in my bed really did make a HUGE difference, two nights and I was damn near human again and now after about 5 days sleeping in bed I’m back to my normal self.
Allow me to repeat this…
You respected her choice because “nothing… suggested that she was in mortal peril” and that Jack is a very, VERY important point that you cannot allow yourself to forget.
Don’t second guess that choice because it was NOT what controlled the outcome.
Find peace.
Steve
The problem is that Grace wasn’t a reliable judge of her own health. She neglected herself, didn’t go to doctors as often as she should have, and had a lot of habits that she knew were unhealthy that she stuck with anyway. This was a 40-year battle, with me torn between enabling and being a constant, unbearable nag.
Are you sure it was enabling and not reluctant tolerance.
Are they really different?
Yes I think they’re different. Reluctantly tolerant is much like the Julie Principle, do you think the Julie Principle is enabling?
Sure. But with friends and loved ones, the calculus is different. With criticism of others, the Julie Principle response is to just stop complaining about what is open and obvious and will never change.
We can only act on what we know, and the universe doesn’t play fair. Even now, you don’t know if you made a “wrong” decision, and you never will. It’s in our nature to agonize over these things, though we know that won’t help. Maybe knowing that we grieve with you can bring some ease. (I have my own story re my mother, but I’ll spare you that.)
Talk it out with Spuds; he may be your best grief counselor.
How wrenching, Jack. I am wishing you peace and comfort in this time of intense grief.
Jack, I can only reiterate the don’t play the “if I only had. . . “game. It does seem to me that you use your writing to manage? (I cannot think of a better word) emotions. Writing may help alleviate the pain of loss but such thoughts need not be shared.
What works for me is ,that what I have difficulty to express verbally, to write out my thoughts and file them away. This prevents me from getting mired in the what if game that plays out in my mind, usually late at night which compounds the hurt.
Based on the comments I have seen here, you are rather an important figure in many of our lives even if we have never met. I think you can rest assured that we are all sharing in your grief because we too hurt when someone who means a great deal to us hurts.
I hope you find peace in the knowledge that you had many years of happiness together.
I am deeply sorry for what you are going through. Your writing is a gift that I look forward to opening every day. Thank you for that.
There’s a prayer in the burial service of a 19th century Anglican Prayerbook that has meant a lot to our family in times of great loss. It says in part: “…and life is eternal; and love is immortal; and death is only a horizon; and a horizon is nothing save the limit of our sight.”
Jack,
don’t be hard on yourself, you respected your wife’s decision. My 85 year old father has 2 pages of medical issues. None of which decrease his mental faculties. I respect his opinion and still give him my concerns. It is a dialectic that may well end in his death, that is life. No one gets out alive, doing your best to treat everyone with respect and consideration will serve you well, this includes yourself, sir.
grace,
Vitaeus
Dear Mr. Marshall,
I don’t mean to reduce your feelings of remorse to a formula (and hope not to be doing that), but it may be helpful to remember that bargaining (‘if only . . . “) is a stage of the grieving process.
Such a shock for you and your family. I am so sorry.
Dear Jack,
I lost my husband of 54 years in 2021. I had been his caregiver during his eight year battle with lung cancer and the after effects of chemo treatments which caused him to have a stroke with other complications. On Sunday evening before he passed his oxygen dropped. I thought something was wrong with the machine so I hooked him up to an oxygen bottle. His oxygen improved so to me that was confirmation that I was correct. The next morning, after noticing he wasn’t wearing the cannula, his oxygen had dropped to 55. I put it back on him but his oxygen only raised to 77. He wanted to eat breakfast before I called EMS so I waited, not realizing he was in respiratory failure. In summary, he was taken to the ER, stabilized, and admitted. I stayed the night, helped with his breakfast that morning, then went home to change clothes. While I was gone he went into cardiac arrest and was put on the ventilator. I blamed myself for not being there when it happened, for not getting him to the ER sooner, and I then felt guilty for leaving him at night while he was on the ventilator. I had never left his side before when he was in ICU. I have looked back over those eight years I’ve caring for him with guilt and I think of all the things I could have done differently. Sometimes the grief is so overwhelming that it almost takes my breath away but there is one thing I know for sure, my husband would NEVER want me to feel guilty. Neither would your Grace. And know this, every feeling, every thought from this point on is natural. We all handle grief differently and it’s never easy but peace will eventually come and fun loving memories will return to overshadow all the last dark ones.